A palliative care rapid access clinic reduces emergency department visits: a retrospective single centre analysis

Patients with palliative care needs often rely on emergency departments for management of acute symptoms due to limited access to timely and appropriate outpatient care, however they can be poorly equipped to meet patients' complex needs. Rapid access clinics exist for addressing health issues such as chest pain but are not routinely established for palliative care. In 2020, the Sunshine Coast Health Palliative Care Service introduced a rapid access clinic to address patients' unmet acute care needs. This research aimed to understand the impact on clinical outcomes.

A retrospective observational analysis of patient health records was undertaken for 283 admissions for 172 patients who attended the clinic between 1 January 2020 and 31 December 2022, and included demographic and diagnostic information, reason for admission and date of death. Statistical analysis of differences using the chi squared test was conducted for age (< 70 years vs. ≥ 70 years), gender and mortality at 30 days after discharge from the clinic. Fisher's exact test was used to assess associations between the type of admission and the likelihood of preventing an emergency department visit. Confidence interval was set at 95%.

Attendance at the rapid access clinic was judged to likely result in avoidance of an emergency department visit for 11.7% of admissions. A potentially avoided emergency department visit was associated with mortality within 30 days (22.9%), X² (1)= 9.82, p =.002, and urgent admission to the rapid access clinic (31.5%), p <.001, OR = 22.6 (95% CI: 7.63, 66.87). There were more planned (67.5%) than urgent admissions. Mortality within 30 days of presentation to the clinic was 24.6%, and significantly associated with male gender (31.3%), X² (1) = 6.02, p =.014 and urgent admission (34.8%), X² (1) = 6.7, p =.008.

A newly established palliative care rapid access clinic addressed acute symptoms in a timely manner and may offer a valuable alternative to emergency department care, particularly for patients nearing the end of life. Further prospective research using control groups and validated patient outcome measures would provide more robust evidence about the clinic's effectiveness in optimising end-of-life care and reducing the burden on our emergency departments.